Sleep changes are a normal part of aging, but poor sleep is not something families have to accept. The National Institute on Aging notes that older adults need just as much sleep as younger adults, but they often have more trouble getting it.

Poor sleep affects mood, memory, immune function, and fall risk. This article explains how sleep changes with age and how to create a nighttime routine that promotes better sleep and safety.

How Sleep Changes With Age

Normal age-related sleep changes include:

✓Waking up earlier. The internal clock shifts, making older adults sleepy earlier in the evening and awake earlier in the morning.
✓Sleeping less deeply. Older adults spend less time in deep sleep and more time in light sleep.
✓Waking up more often. Nighttime awakenings become more frequent, often due to the need to use the bathroom, pain, or discomfort.
✓Taking longer to fall asleep. It may take more time to drift off.

These changes are normal. But chronic sleep problems, such as difficulty falling asleep, frequent awakenings, or feeling unrefreshed after sleep, are not normal and should be discussed with a doctor.

What Disrupts Sleep in Older Adults

Medical Conditions

✓Arthritis pain
✓Heartburn or GERD
✓Frequent urination (overactive bladder, enlarged prostate)
✓Restless leg syndrome
✓Sleep apnea
✓Depression and anxiety
✓Dementia (which can disrupt the sleep-wake cycle)

Medications

Some medications interfere with sleep:

✓Diuretics (increase nighttime urination)
✓Beta blockers (can cause nightmares)
✓Some antidepressants
✓Decongestants
✓Corticosteroids

Ask the doctor or pharmacist if any of your loved one's medications could be affecting sleep and whether timing adjustments would help.

Lifestyle Factors

✓Caffeine in the afternoon or evening
✓Alcohol (helps you fall asleep but disrupts sleep later)
✓Lack of physical activity
✓Napping too much during the day
✓Irregular sleep schedule

Environmental Factors

✓Noise
✓Light
✓Temperature (older adults may feel cold at night)
✓Uncomfortable bed or pillows

Creating a Better Nighttime Routine

Set a Consistent Schedule

✓Go to bed at the same time each night
✓Wake up at the same time each morning
✓Avoid napping after 3 PM
✓If a nap is needed, keep it to 30 minutes or less

Wind Down Before Bed

Create a calming pre-sleep routine:

✓Turn off the TV and phone 30 to 60 minutes before bed
✓Read a book, listen to soft music, or do a gentle activity
✓Avoid stimulating conversations or news
✓Dim the lights

Manage Light Exposure

Light is the strongest signal for the body's internal clock:

✓Get bright light during the day, especially in the morning
✓Avoid bright screens before bed
✓Keep the bedroom dark at night
✓Use blackout curtains if street lights are a problem

Watch Food and Drink

✓Avoid large meals within 3 hours of bedtime
✓Avoid caffeine after 2 PM
✓Avoid alcohol within 3 hours of bedtime
✓A light snack before bed can help, such as crackers and cheese or a small bowl of cereal

Address Bathroom Trips

Frequent nighttime bathroom trips disrupt sleep:

✓Limit fluids in the evening (but do not restrict during the day)
✓Use the bathroom right before bed
✓Consider a bedside commode if the bathroom is far away
✓Ask the doctor about timing diuretic medications for the morning

Create a Comfortable Sleep Environment

✓Keep the bedroom cool (65 to 70 degrees is ideal)
✓Use comfortable bedding
✓Reduce noise with earplugs or a white noise machine
✓Ensure the room is dark
✓Use a night light for safety if your loved one gets up at night

Manage Pain

If pain is keeping your loved one awake, talk with the doctor about pain management. Taking pain medication before bed may help.

Sleep Safety at Night

Nighttime is also a safety concern. Falls often happen when older adults get up in the dark to use the bathroom. See our article on nighttime safety for seniors for detailed guidance.

Key safety steps:

✓Install night lights along the path from bedroom to bathroom
✓Clear the path of clutter and rugs
✓Keep a phone or medical alert device on the nightstand
✓Consider a bedside commode if the bathroom is far

When Sleep Problems Need Medical Attention

Talk with a doctor if your loved one:

✓Snores loudly or stops breathing during sleep (possible sleep apnea)
✓Has difficulty falling asleep that lasts more than a few weeks
✓Wakes up frequently and cannot get back to sleep
✓Feels exhausted during the day despite sleeping
✓Acts out dreams during sleep
✓Has sudden changes in sleep patterns

Sleep apnea is common in older adults and is often undiagnosed. It causes pauses in breathing during sleep and can lead to daytime sleepiness, heart problems, and cognitive changes. A sleep study can diagnose it.

A Final Note

Good sleep is essential for health. While sleep patterns change with age, chronic sleep problems are not normal and should not be ignored. A good nighttime routine, combined with attention to medical and environmental factors, can make a significant difference.

If your loved one has nighttime safety concerns or needs overnight support, Healthy at Home offers a free care assessment. Our caregivers can provide overnight care and help with nighttime routines.

Sleep Changes in Older Adults: Creating a Safer Nighttime Routine